A woman with her hands on her stomach

New and improved treatments for irritable bowel syndrome (IBS)

Published: 13 February 2024

People with IBS are benefiting from better ways to manage their condition, thanks to a Southampton researcher whose commitment to finding new and improved treatments was sparked more than 15 years ago through her clinical work as a GP.

Professor Hazel Everitt, Professor of Primary Care Research, sees lots of patients in general practice with IBS but found there were limited treatment options to help them.

The National Institute for Health and Care Excellence (NICE) guidelines at the time recommended GPs ‘consider’ referring patients to Cognitive Behaviour Therapy (CBT) for IBS but that more research evidence was needed.

Hazel brought together a team of collaborators, successfully applied for National Institute of Health and Care Research (NIHR) research funding, and the results of her work are now being used to treat patients in the NHS and the USA. They also have the potential to have further impact worldwide.

Living with IBS

IBS is a common and often debilitating condition that has no cure, affects quality of life and incurs high health care costs in both primary and secondary care.

The key symptom is abdominal pain or discomfort linked to changes in bowel habit and commonly bloating. Psychological factors such as stress can trigger or worsen symptoms. 

Although CBT is recommended in NICE guidelines for IBS, for patients with ongoing symptoms for more than a year, there is very limited access.

NICE guidelines also recommend GPs consider prescribing low dose amitriptyline for IBS when initial interventions such as dietary and lifestyle change have been ineffective. However, previously there was insufficient evidence about its effectiveness and GPs rarely prescribed it.

Impacts of the research

Hazel, who is internationally recognised for her IBS research, has led two studies into CBT in IBS at Southampton and was Co-Chief Investigator on the ATLANTIS project, a trial of low dose amitriptyline for IBS in primary care with colleagues at the Universities of Leeds and Bristol.

The first IBS study, Managing IBS in primary care (MIBS), developed a CBT for IBS self-management website called Regul8. The second study, Accessing Cognitive Behavioural Therapy in IBS (ACTIB), was the largest trial of CBT for IBS worldwide.

The ACTIB trial showed that telephone and online CBT for IBS led to significant clinical improvements in symptoms at 12 months that were sustained at 24 months. The telephone CBT for IBS self-management programme is now available across the country through the NHS Improving Access to Psychological Therapy (IAPT) service.

Regul8 has been developed into an app by Mahana Therapeutics in the USA and been approved by the Food and Drug Administration (FDA). 

The ATLANTIS trial found that low doses of the amitriptyline were effective at reducing IBS symptoms at 6 months and recommended GPs offer it to patients with ongoing IBS symptoms. The results have been published in The Lancet, won prizes at conferences and are being disseminated globally.

The next steps

The research has the potential to have further impact worldwide. Currently investigations are being carried out to expand the IBS CBT digital therapeutics into new markets and team is hoping that the results from their ATLANTIS study will lead to more patients being offered amitriptyline as a second-line treatment in primary care.

My work as a GP sparked a commitment to find better treatment options for patients with IBS. It is wonderful that this research is changing clinical practice to help improve the quality of life of people worldwide.
Professor of Primary Care Research

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